Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study.

Area of Science:

• Healthcare implementation science
• Clinical practice guideline translation
• Evidence-based practice in rehabilitation

Background:

• Translating evidence into practice is a critical step in evidence-based practice.
• Medical record audits identify evidence-practice gaps.
• Audit feedback and targeted interventions can address local barriers to practice change.

Purpose of the Study:

• To identify barriers and enablers to implementing multiple stroke guideline recommendations in an Australian stroke unit.

Main Methods:

• Qualitative methodology using group and individual interviews with 28 allied health, nursing, and medical professionals.
• Interviews focused on barriers and enablers for specific stroke guideline recommendations.
• Thematic analysis of qualitative data using theoretical domains framework.

Main Results:

• Six key barriers were identified: beliefs about capabilities, beliefs about consequences, memory/attention to best practices, knowledge/skills, intention/motivation, and resources.
• Barriers and enablers varied across different professional disciplines.
• Examples include occupational therapists needing new skills for sensation/neglect management (barrier) and physiotherapists possessing skills for mobility rehabilitation (enabler).

Conclusions:

• Findings contribute to understanding barriers in implementing multiple guideline recommendations.
• Sexuality education and depression screening presented major implementation challenges.
• Limited knowledge and skills were common barriers; detailed online resources may help overcome these.